hmo/psn quarterly meeting performance improvement projects

HMO/PSN Quarterly MeetingPerformance Improvement Projects

September 26 , 2011

Presenter:

Christi Melendez, RN, CPHQProject Manager, PIP Review Team

Presentation Topics

• Discuss Well-Child Visits in the First 15 Months of Life—Six or More Visits

• Results

• Discuss Validation Results

• Next Steps

• Important Dates

HMO/PSN Non-Reform

Well-Child Visits in the First 15 Months of Life—

Six or More VisitsBaseline –

• Thirteen plans provided baseline results

• The overall rate for the Non-Reform HMOs was 34.0 percent

• The rates ranged from 11.1 to 80.0 percent

HMO/PSN Non-Reform


Six or More VisitsRemeasurement 1 –

• Twelve plans provided Remeasurement 1 results

• Seven plans reported improved rates from baseline to Remeasurement 1; all increases were statistically significant

• The overall rate increased from 34.0 percent to 37.1 percent

HMO/PSN Non-Reform



• Ten plans provided Remeasurement 2 results

• Seven plans reported improved rates from Remeasurement 1 to Remeasurement 2; two of the increases were statistically significant

• The overall rate decreased from 37.1 percent to 30.0 percent

HMO/PSN Non-Reform



• Five plans provided Remeasurement 3 results

• Two of the five plans reported improved rates from Remeasurement 2 to Remeasurement 3; none of the increases were statistically significant

• The overall rate decreased from 30.0 percent to 27.4 percentNOTE: Plans were not required to report Remeasurements 2 or 3 for

calendar year 2010

HMO/PSN Non-Reform Baseline

Well-Child Visits in the First 15 Months of Life—Six or More Visits

HMO/PSN Non-Reform Baseline to Remeasurement 1


HMO/PSN Non-Reform Statistically Significant Improvement and

Sustained Improvement Validation Results for HMO PIPs Demonstrating Improvement


MCO MCO Type Statistically Significant Improvement

Sustained Improvement

Citrus Health Care, Inc. HMO Non-Reform Humana Family c/o Humana Medical Plan, Inc.

HMO Non-Reform

Jackson Memorial Health Plan HMO Non-Reform Preferred Medical Plan, Inc. HMO Non-Reform United Healthcare of Florida, Inc.—AmeriChoice HMO Non-Reform Vista Healthplan, Inc.—Buena Vista Medicaid HMO Non-Reform Vista Healthplan, Inc.—Vista South Florida HMO Non-Reform Wellcare Health Plans, Inc.—Healthease of Florida, Inc. HMO Non-Reform Wellcare Health Plans, Inc.—Staywell of Florida, Inc. HMO Non-Reform

HMO/PSN Reform


Baseline –

• Seven plans provided baseline results

• The overall rate for the Reform HMO/PSNs was 37.5 percent

• The rates ranged from 10.3 percent to 60.0 percent

HMO/PSN Reform


Remeasurement 1 –

• Three plans provided Remeasurement 1 results

• One of the three plans reported an improved rate from baseline to Remeasurement 1, the increase was not statistically significant

• The overall rate improved from 37.5 percent to 52.7 percent

Remeasurement 2 –

• One plan provided a Remeasurement 1 rate of 46.2 percent; the result was below the plan’s baseline rate of 48.7 percent

NOTE: Plans were not required to report Remeasurements 1 or 2 for calendar year 2010

HMO/PSN Reform Baseline


HMO/PSN Reform Baseline to Remeasurement 1


HMO Validation Results Across All PIPs (Reform and Non-Reform)

Study Stage Activity

Percentage of Applicable Elements

Met Partially

Met Not Met

Design

I. Appropriate Study Topic 96%

(288/299) 2%

(6/299) 2%

(5/299)

II. Clearly Defined, Answerable Study Question(s) 87%

(90/104) 13%

(14/104) 0%

(0/104)

III. Clearly Defined Study Indicator(s) 92%

(283/307) 7%

(22/307) 1%

(2/307)

IV. Correctly Identified Study Population 89%

(136/153) 11%

(17/153) 0%

(0/153)

Design Total 92%

(797/863) 7%

(59/863) 1%

(7/863)

Implementation

V. Valid Sampling Techniques (if sampling was used) 100%

(59/59) 0%

(0/59) 0%

(0/59)

VI. Accurate/Complete Data Collection 89%

(319/358) 4%

(15/358) 7%

(24/358)

VII. Appropriate Improvement Strategies 89%

(108/121) 9%

(11/121) 2%

(2/121)

Implementation Total 90%

(486/538) 5%

(26/538) 5%

(26/538)

Outcomes

VIII. Sufficient Data Analysis and Interpretation 79%

(206/261) 10%

(26/261) 11%

(29/261)

IX. Real Improvement Achieved 66%

(66/100) 0%

(0/100) 34%

(34/100)

X. Sustained Improvement Achieved 56%

(9/16) 19%

(3/16) 25%

(4/16)

Outcomes Total* 75%

(281/377) 8%

(29/377) 18%

(67/377)

Overall Percentage of Applicable Evaluation Elements Scored Met 88%

(1564/1778) * The activity or stage total may not equal 100 percent due to rounding.

PSN Validation Results Across All PIPs

Study Stage PSNs by Activity

Percentage of Applicable Elements

Met Partially

Met Not Met

Design

I. Appropriate Study Topic 100%

(94/94) 0%

(0/94) 0%

(0/94)

II. Clearly Defined, Answerable Study Question(s) 100%

(32/32) 0%

(0/32) 0%

(0/32)

III. Clearly Defined Study Indicator(s) 99%

(91/92) 1%

(1/92) 0%

(0/92)

IV. Correctly Identified Study Population 98%

(42/43) 2%

(1/43) 0%

(0/43)

Design Total 99%

(259/261) 1%

(2/261) 0%

(0/261)

Implementation

V. Valid Sampling Techniques (if sampling was used) Not

Applicable Not

Applicable Not

Applicable

VI. Accurate/Complete Data Collection 93%

(94/101) 6%

(6/101) 1%

(1/101)

VII. Appropriate Improvement Strategies 79%

(27/34) 21%

(7/34) 0%

(0/34)

Implementation Total* 90%

(121/135) 10%

(13/135) 1%

(1/135)

Outcomes

VIII. Sufficient Data Analysis and Interpretation 83%

(60/72) 17%

(12/72) 0%

(0/72)

IX. Real Improvement Achieved 50%

(14/28) 25%

(7/28) 25%

(7/28)

X. Sustained Improvement Achieved 100% (1/1)

0% (0/1)

0% (0/1)

Outcomes Total 74%

(75/101) 19%

(19/101) 7%

(7/101)

Overall Percentage of Applicable Evaluation Elements Scored Met 92%

(455/497) * The activity or stage total may not equal 100 percent due to rounding.

Next Steps

What’s Next?• New Collaborative Intervention

• Work Group

• Develop Action Plan

• PIPs submitted to HSAG for validation Wednesday, December 14, 2011

hmo/psn quarterly meeting performance improvement projects

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